An ongoing nationwide prospective surveillance program for invasive H. influenzae b (Hib) disease in Israel enabled us to study the effectiveness of a national infant Hib immunization program, which included all infants born since January 1994.

For the cohort born during the 3 years since January 1994, the vaccine effectiveness was 94.9% for all invasive Hib diseases and 96.6% for meningitis.

The efficacy in fully immunized subjects was 98.7 and 99.5%, respectively.

A herd immunity effect could be observed, since a reduction in cases also occurred among infants too young to be immunized.

No increase in invasive cases caused by S. pneumoniae and N. meningitidis was observed during the study period.

This is the first report outside North America and Western Europe that demonstrates a nationwide extensive reduction of invasive Hib disease within a short time of the introduction of Hib conjugate vaccines to the infant immunization program.